Perception of Insufficient Breast Milk Supply in the United States

Background: Maternal perception of insufficient breast milk supply (PIMS) is cited as the leading reason for premature breastfeeding discontinuation and formula milk supplementation throughout the world. Achieving better understanding of this issue requires thorough examination of factors that influence PIMS. This dissertation study’s purpose was to comprehensively identify relationships between PIMS and its influencing factors by analyzing data from a large, national sample of individuals in the U.S. Method: This study consisted of secondary analyses of data from the Infant Feeding Practices Study II (IFPS-II). A total of 1,442 diverse individuals living across the U.S. who reported breastfeeding discontinuation provided the dataset employed. To identify the prevalence of PIMS and factors influencing PIMS, Chi-Square Test, Wilcoxon rank-sum test, Spearman’s rho correlation analysis, Kruskal Wallis test, logistic regression, and Tobit regression analyses were performed. Results: Among 1,442 respondents to the IFPS-II, 974 (67.55%) reported PIMS as an important reason for their breastfeeding discontinuation. Significant predictors of experiencing PIMS included prolonged time intervals between breastfeeding sessions, less frequent breastfeeding sessions per day, self-reporting that their milk was taking too long to come in, self-reporting that they did not have enough milk in the first 2 weeks postpartum, delayed breastfeeding initiation, prolonged time elapsed until first receiving help with breastfeeding, the baby being fed on a schedule by hospital staff members, and receiving information about infant feeding from the Special Supplemental Nutrition Program for Women, Infants, and Children after controlling for confounders. In addition, among the 974 respondents who reported stopping breastfeeding due to PIMS, key predictors of PIMS levels included delayed breastfeeding initiation, exclusive formula feeding at hospital discharge, not using a pacifier in the hospital, and perceived high importance of family members’ opinions about infant feeding decisions after controlling for confounders. Conclusion: This research sheds light on the influence of multifaceted determinants of PIMS, with attention not only to individual factors but also to sociocultural and structural factors. Hence, the findings have implications for multi-level strategies to develop effective, culturally appropriate, and sustainable interventions for PIMS reduction and thus could improve overall breastfeeding outcomes in the U.S.